To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Wound drainage after plastic and reconstructive surgery of the breast. Emiroglu M, Salimoglu S, Karaali C, et al. Med Decis Making. GP Notebook. Handschin AE, Bietry D, Hsler R, et al. These investigators concluded that their findings do not support the use of completely autologous platelet gel to improve outcomes after reduction mammoplasty. Kasielska-Trojan and associates (2018) analyzed digit ratio in relation to estrogen receptor (ER) and progesterone receptor (PR) expression and verified digit ratio (2D: 4D) as a marker of ER and PR over-expression in the male breast. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Brown DM, Young VL. padding: 15px; The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Aesthetic Plast Surg. A population-level analysis of bilateral breast reduction: does age affect early complications? In total there were 306 women in the 3 trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Sollie M. Management of gynecomastia-changes in psychological aspects after surgery-a systematic review. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. Plast Reconstr Surg. I have recently met with my primary doctor after speaking to my insurance company (aetna) for months about getting a breast reduction. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. 2006;9(2):109-114. Transient pain that may occur as the breast enlarges and the capsule is stretched; these symptoms may be managed with analgesics. 2004;113(1):436-437. Ann Plast Surg. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. 1997;100(4):875-883. For these reasons, there is insufficient evidence to support the use of reduction mammoplasty, without regard to the size of the breasts or amount of breast tissue to be removed, as a method of relieving chronic back, neck, or shoulder pain. Brown MH, Weinberg M, Chong N, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. No necrosis, systemic infection, or muscle paralysis was reported. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Aesthetic Plast Surg. Plast Reconstr Surg. No data were provided on loss to follow-up. World J Surg. 2007;119(4):1159-1166. Reduction mammoplasty: Criteria for insurance coverage. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. The requirement for coverage is that the amount of breast tissue to be removed has to be enough to improve your symptoms or function. Reduction (or some cases augmentation) mammoplasty and related reconstructive procedures on the unaffected side for symmetry are also considered medically necessary. However, it is unclear if there is any evidence to support this practice. Breast Concerns of Adolescents. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. For example, at a body surface area of 1.5m, Aetna requires a minimum weight of 385 grams removed from each breast, whereas the Schnur scale would only require 260g. Prostate Cancer Prostatic Dis. Third, reliable evidence is especially important for pain interventions, because of the waxing and waning nature of pain and the susceptibility of this symptom to placebo effects and other biases that may confound interpretation of study results. 2009;7(2):114-119. Philadelphia, PA: WB Saunders Company; 2008; Ch 73. display: none; z-index: 99; The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. 1999;103(6):1674-1681. Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. 2009;19(3):e85-e90. While the efficacy of radiotherapy as a therapeutic modality for gynecomastia was also established, it was shown to be less effective than other available options. Gynecomastia. Hoyos and colleagues (2021) stated that male chest definition surgery and patients complaining of breast tissue over-growth have been increasing in recent decades. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. J Am Coll Surg. They investigated effects of age on 30-day surgical outcomes for reduction mammoplasty with a goal of improving patient care, counseling, and risk stratification on 3537 patients. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Criteria for reduction mammoplasty surgery from the American Society of Plastic Surgeons (ASPS, 2002; ASPS, 2011) states, among other things, that breast weight or breast volume is not a legitimate criterion upon which to distinguish cosmetic from functional indications. Determinants of surgical site infection after breast surgery. Plast Reconstr Surg. Am Surg. Can objective predictors for operative success be identified? Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. 1995;95(1):77-83. They stated that no data are available for breast augmentation or breast reconstruction, and this requires investigation. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 %). Schnur PL, Schnur DP, Petty PM, et al. --> } @media print { The authors concluded that with proper patient selection, reduction mammoplasty can be performed safely on older patients. 2013;71(5):471-475. Annu Rev Med. Each surgeon who participated in the study reported on the height, weight, and volume of reduction of their last 15 to 20 patients, and each surgeon provided their intuitive sense regarding the motivation of each patient for breast reduction surgery. (This refers to actual breast tissue only; any fatty tissue removed doesn't count.) Gynecomastia: A systematic review. color: #FFF; ul.ur li{ Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Li CC, Fu JP, Chang SC, et al. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. Plast Reconstr Surg. In a prospective, cohort study, these investigators evaluated the efficacy of tamoxifen therapy in resolving this condition. A total of 2779 patients were identified with a mean age of 42.7 (14.1) years and BMI of 31.6 (7.0) kg/m. 2007;36(2):497-519. Collins ED, Kerrigan CL, Kim M, et al. } font-size: 18px; 2018;24(6):1043-1045. Guidelines for Adolescent Health Care. For those with large breasts, breast reduction surgery can ease discomfort and improve appearance. Kalliainen LK; ASPS Health Policy Committee. Bruhlmann Y, Tschopp H. Breast reduction improves symptoms of macromastia and has a long-lasting effect. list-style-type: lower-alpha; Khan SM, Smeulders MJ, Van der Horst CM. The health burden of breast hypertrophy. Medical therapy should be aimed at correcting any reversible causes (e.g., drug discontinuance). Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Ages ranged from 18 to 66 years. } The authors concluded that the limited evidence available showed no significant benefit of using post-operative wound drains in reduction mammoplasty, although LOS may be shorter when drains are not used. In the case of breast reduction, however, for insurance purposes, it . A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Reduction mammaplasty. } Only 8 (9.9 %) patients did not have a complete resolution following tamoxifen therapy, of which 2 underwent subsequent surgical resection of their symptomatic gynecomastia.
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